Aging Research Characterizing Health Equity via Social determinants (ARCHES)

通过社会决定因素表征健康公平的老龄化研究 (ARCCHES)

• 批准号: 10301671
• 负责人: Ganesh M Babulal
• 金额: $ 78.7万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10301671
• 关键词: Adult; Affect; African American; Age; Aging; Alzheimer disease prevention; Alzheimer' s Disease; Alzheimer' s disease pathology; Alzheimer' s disease risk; Alzheimer’s disease biomarker; Amyloid Proteins; Awareness; Behavioral; Biological; Biological Markers; Biological Models; Biostatistical Methods; Blood; Cerebrospinal Fluid; Chronic stress; Clinical; Cognition; Cognitive; Communities; Complex; Coping Behavior; Data; Dementia; Detection; Development; Diagnosis; Discrimination; Economics; Education; Educational workshop; Elderly; Employment; Enrollment; Environmental Risk Factor; Exposure to; Genetic; Genomics; Goals; Health; Heterogeneity; Hippocampus (Brain); Image; Impaired cognition; Inflammation; Inflammatory; Intervention; Knowledge; Life Cycle Stages; Life Style; Link; Longitudinal Studies; MRI Scans; Magnetic Resonance Imaging; Maps; Measures; Mediator of activation protein; Mental Depression; Methods; Modeling; Molecular; National Institute on Aging; Neighborhoods; Nerve Degeneration; Neurologic; Neuropsychological Tests; Neuropsychology; Participant; Plasma; Population; Population Heterogeneity; Population Study; Prevalence; Recording of previous events; Research; Research Methodology; Resources; Risk; Risk Factors; Sample Size; Sampling; Socioeconomic Status; Stress; Symptoms; System; Testing; Time; United States; Validation; Vascular Diseases; White Matter Hyperintensity; Work; base; brain health; cognitive function; cognitive testing; cohort; community based participatory research; dementia risk; depressive symptoms; dynamic system; epidemiology study; follow-up; health care availability; health care service utilization; health disparity; health equity; healthy aging; high risk; indexing; inflammatory marker; innovation; multidisciplinary; neuroimaging; novel; pre-clinical; prospective; psychosocial; recruit; social; social culture; social determinants; social factors; social health determinants; socioeconomics; suburb; tau Proteins; theories; trustworthiness

PROJECT SUMMARY/ABSTRACT Our long-term goal is to employ innovative community based participatory research to establish a community advisory board, to collaborate with our community partners to recruit, enroll, and retain a cohort of Black participants and, then, to examine causal mechanisms that increase the risk of Alzheimer disease (AD) within the community cohort. The long preclinical stage of AD, as reflected in biomarkers among adults, is a key risk factor of symptomatic AD. However, despite Blacks having a higher risk of developing AD, recent studies suggest that they have less abnormal levels of biomarkers than Whites in cognitively normal samples. This study aims to examine other risk factors of cognitive decline and AD such as depression, stress, and social determinants of health (SDOH) in a representative sample of Black participants. This research is significant because there are nearly 46 million Black Americans, comprising 13% of the population in the United States. The Black older adult population is expected to increase, from 4.4 million older adults in 2016 to 12.1 million by 2060. Despite these demographic projections, Blacks are significantly underrepresented in AD research. An almost exclusive focus on Whites has created a knowledge gap in understanding how SDOH mechanisms affect diverse populations. Closing this knowledge gap soon is critical since epidemiological studies suggest that Blacks are at twice the risk of AD compared to Whites. Our Specific Aims will (1) Establish a cohort of middle-to-older age Black adults (N=300) using community- based participatory research to understand the unique social, environmental, and economic barriers related to AD risk, (2) Determine the impact of depression, stress, and a novel, theory-based SDOH composite index (CI) on cognitive functioning in participants who are cognitively normal with and without preclinical AD, and (3) Test the association between white matter hyperintensities (WMH) and hippocampal volume (HV) with the SDOH-CI in a subset of participants (N=150) with magnetic resonance imaging (MRI) data. To test our Aims, we have assembled a multidisciplinary team with expertise in AD, SDOH, community- based participatory research and system dynamics, community mobilization, stress and depression, plasma biomarkers, genetics, neuroimaging, neuropsychology, and biostatistical methods. Participants will undergo a one-time blood draw for AD biomarker profiling, cognitive assessment using a neuropsychological battery, and participate in one MRI scan session. Participants will also participate in workshops, complete a comprehensive battery of SDOH measures mapped onto the National Institute of Aging’s Health Research Disparities Framework, and clinical, neurological, and neuropsychological tests annually for up to five years. Once obtained, this knowledge of how within-group heterogeneity in cognitive functioning and AD risk is impacted by SDOH may better support effective AD intervention and treatment for Black Americans.

项目总结/摘要 我们的长期目标是采用创新的社区参与式研究， 社区咨询委员会，与我们的社区合作伙伴合作，招募，登记和保留一批 黑人参与者，然后，检查因果机制，增加阿尔茨海默病（AD）的风险 在社区队列中。AD的长期临床前阶段，如在成人中的生物标志物所反映的，是一个长期的临床前阶段。 症状性AD的关键危险因素。然而，尽管黑人患AD的风险更高， 研究表明，在认知正常的样本中，他们比白人具有更少的异常生物标志物水平。 这项研究旨在检查认知能力下降和AD的其他危险因素，如抑郁，压力， 健康的社会决定因素（SDOH）在黑人参与者的代表性样本。 这项研究意义重大，因为美国有近4600万黑人，占美国人口的13%。 美国的人口。预计黑人老年人口将从440万增加到440万。 到2060年将达到1210万人。尽管有这些人口预测，黑人 在AD研究中的代表性不足。对白人的几乎独家关注造成了知识差距， 了解SDOH机制如何影响不同人群。尽快弥合这一知识差距至关重要 因为流行病学研究表明，黑人患AD的风险是白人的两倍。 我们的具体目标是：（1）使用社区-建立一个中年至老年黑人成年人队列（N=300）， 基于参与式研究，以了解独特的社会，环境和经济障碍， AD风险，（2）确定抑郁、压力和一种新的基于理论的SDOH综合指数（CI）的影响 对认知功能正常的有和没有临床前AD的参与者的认知功能的影响，以及（3）测试 白色高信号（WMH）和海马体积（HV）与SDOH-CI之间的关系 在具有磁共振成像（MRI）数据的参与者子集（N=150）中。 为了测试我们的目标，我们组建了一个多学科团队，拥有AD，SDOH，社区- 基于参与性研究和系统动力学，社区动员，压力和抑郁，血浆 生物标志物、遗传学、神经影像学、神经心理学和生物统计学方法。参加者将接受 用于AD生物标志物分析的一次性抽血，使用神经心理成套测试进行认知评估，以及 参加一次MRI扫描。参加者还将参加研讨会，完成一个全面的 一组SDOH指标映射到国家老龄化研究所的健康研究差异 框架，临床，神经和神经心理学测试每年长达五年。 一旦获得，这种认知功能和AD风险的组内异质性的知识， SDOH的影响可能更好地支持对美国黑人的有效AD干预和治疗。